人工液胸辅助高强度聚焦超声治疗儿童肝母细胞瘤安全性的观察

Efficacy and security of high-intensity focused ultrasound in the treatment of child hepatoblastoma with the aid of artificial hydrothorax

目的：评估在全身麻醉下人工液胸辅助高强度聚焦超声（high-intensity focused ultrasound,HIFU）治疗儿童肝母细胞瘤的有效性及安全性。方法：回顾性分析在全身麻醉气管插管下,18例肝母细胞瘤患儿,在其右侧胸腔注入200~300 ml生理盐水建立人工液胸。分别于气管插管后5 min（T0）、人工液胸建立后10 min（T1）、HIFU治疗30 min（T2）、1 h（T3）、2 h（T4）及治疗结束时（T5）记录有创血压（invasive arterial pressure,IABP）、心率（heart rate,HR）、气道峰压（peak airway pressure,Ppeak）、胸肺顺应性（compliance of lung,Cmpl）、呼末二氧化碳（end-tidal carbon dioxide partial press,PETCO2）、血氧饱和度（oxygen saturation,SpO2）;并在以上各时点及HIFU治疗后24 h（T6）作动脉血气分析。HIFU治疗后第1天及第7天行胸部X线摄片,观察双肺和胸水转归,治疗前后行彩超及增强MRI对比治疗效果。结果：在HIFU治疗过程中,患儿各血流动力学指标均保持稳定。Ppeak在建立人工液胸后较建立人工液胸前明显升高（P〈0.05）,且持续维持在一个较高水平。Cmpl在建立人工液胸后较建立人工液胸前降低（P〈0.05）。PETCO2在HIFU治疗30 min以后较注入胸水前明显升高（P〈0.05）;动脉血气分析中PO2及PCO2均较建立人工液胸前增高（P〈0.05）,但pH在各个时间点差异无统计学意义（P〉0.05）,且以上呼吸参数改变均在临床安全范围内。胸片提示所有患儿胸水在术后7 d内全部吸收,且均未出现气胸、血胸等严重并发症。术后影像学检查（MRI或者增强CT）提示所有患儿病灶均达到预定消融效果。结论：全身麻醉下建立人工液胸辅助HIFU治疗儿童肝母细胞瘤是有效、安全的。

Objective：To evaluate the availability and security of high-intensity focused ultrasound（HIFU）in the treatment of child hepatoblastoma with the aid of artificial hydrothorax. Methods：Fourteen children（18 lesions）with hepatoblastoma received general anesthesia using trachea cannula. 200-300 ml saline was injected into the right thoracic cavity to turn artificial pleural fluid. Mean invasive arterial pressure（IABP）,heart rate（HR）,peak airway pressure（Ppeak）,compliance of lung（Cmpl）,end-tidal carbon dioxide partial press（PETCO2）and oxygen saturation（SpO2）were observed and recorded separately at 5 min after intubation（T0）,10 min after establishment of artificial hydrothorax（T1）,30 min after HIFU treatment（T2）,1 h after HIFU treatment（T3）,2 h after HIFU treatment（T4）and at the end of HIFU treatment（T5）. Blood gad analysis was made at T0-T5and 24 h after HIFU treatment（T6）. On the 1st d and the 7th d after HIFU treatment,chest X-ray was made to evaluate the hydrothorax and lungs. Before and after HIFU treatment MRI was made to evaluate the availability. Results：During HIFU treatment,all children were steady in various indicators of haemodynamics. Ppeak was increased significantly after the establishment of artificial hydrothorax compared with that of T0（P＆lt;0.05）and was maintained at the high level;Cmpl was decreased significantly after the establishment of artificial hydrothorax compared with that of T0（P＆lt;0.05）. PETCO2was increased significantly after T2（P＆lt; 0.05）;PO2and PCO2were both increased significantly after T1（P＆lt;0.05）. But pH values were not change significantly（P＆gt; 0.05）and the fluctuations of the respiratory parameters above were all within the safety margin. X-ray showed that artificialhydrothorax was absorbed within 7 d after HIFU treatment. Severe complications like pneumothorax or haemothorax were not observed. Postoperative imaging studies（MRI or enhanced CT）prompted all children with lesions reach a predetermined radio frequency ablation effect. Conclusion：HIFU is effective and safe in the treatment of child hepatoblastoma with the aid of artificial hydrothorax.